Analysis of risk factors for severe acute poisoning in children.

OBJECTIVE: To identify independent risk factors for the progression of acute poisoning to severe cases in children, and to provide a basis for early clinical identification and intervention. METHODS: A retrospective study was conducted to collect the clinical data of hospitalized children with acute poisoning at Tianshui First People's Hospital from January 1, 2018 to December 31, 2025. According to the Poisoning Severity Score (PSS), patients were divided into the severe group (≥3 points) and the non-severe group (<3 points). Variables that were statistically significant in univariate analysis were included in binary logistic regression analysis to identify independent risk factors for severe poisoning. RESULTS: A total of 726 children with acute poisoning were enrolled, including 79 (10.9%) severe cases and 647 (89.1%) non-severe cases. Two deaths occurred, with a case fatality rate of 0.3%. The difference across age groups was statistically significant (χ 2 = 10.451, P = 0.015), with adolescents accounting for the highest proportion of severe cases (48.1%, 38/79). Multivariate logistic regression analysis revealed that gastric lavage was significantly associated with lower odds of severe poisoning (OR = 0.355, 95% CI: 0.157-0.800, P = 0.013); antidote use was associated with an increased risk of severe poisoning (OR = 3.156, 95% CI: 1.933-5.152, P < 0.001), while left-behind children (OR = 3.013, 95% CI: 1.558-5.828, P = 0.001) and self-poisoning (OR = 2.113, 95% CI: 1.283-3.481, P = 0.003) were independent risk factors. The ROC curve showed an area under the curve (AUC) of 0.710 (95% CI: 0.645-0.775). CONCLUSIONS: Gastric lavage associated with a lower risk of severe poisoning in this pediatric cohort. When strictly indicated, it may remain a procedure of clinical value. Left-behind children and those with self-poisoning are high-risk populations requiring enhanced family supervision, early recognition, and psychological intervention. The association between antidote use and increased risk of severe poisoning likely reflects confounding by indication, and should not delay necessary antidotal therapy.